Individual
MR. TUCKER CROXALL CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2046 ALLEN AVE RM 100, ALTADENA, CA 91001-3424
(626) 660-9419
Mailing address
204 MAIN ST. SUITE 4091, NEWPORT BEACH, CA 92661-9998
(949) 244-9982
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
28707
CA
1041S0200X
School Social Worker
18784
CA
1041S0200X
School Social Worker
Primary
28707
CA
Other
Enumeration date
03/14/2007
Last updated
11/02/2012
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